MTBA / CA Insurance claims

So I’ve had a pretty big crash and need surgery on my elbow.

It is going to cost and whilst I have MTBA cover, which says it covers private surgery etc it is by reimbursement only.

Any have any experience with this?

Painful? or easy to get your money back.


(p.s if you don’t have ambulance cover at least -get it)

Sorry to hear Mike. Can’t help you with the to and fro as I never binned it bad enough when I was racing. Hope it ends up ok!

Ah man - sucks. Hope they’ll be able to fix you up, preferably to better-than-before condition!

No experience with MTBA cover - there’s a mention of a maximum in article 2 (Benefit). Seems like you’d spend $5,000 pretty quickly?

yes good point, i’ve got an appointment with a specialist/surgeon on thurs, so see what happens.

The license will cover some income loss and extras at least.

A positive first hand review here -

Well, I’ll post up my experiences as an example.

Sorry to hear about your crash MikeD.

When I broke my collarbone last year at DISC, I ended getting a second opinion and had mine plated self funded private.

I assumed incorrectly that CA insurance would cover most things so didn’t have private insurance at the time. Once I realised it wouldn’t, I did sign up for private insurance with no waiting period for physio post surgery which helped as I needed 16 sessions for a frozen shoulder!

$5000 minus the excess racks up extremely quickly! Anything Medicare rebatable isn’t covered by the CA insurance so you will be out of pocket there.

With mine, Hospital (stayed overnight) and stainless plate plus screws was around 4.7K. (This plus some of physio was covered by my Cycling Australia insurance).

Surgeon, Anaesthetist, Surgeons assistant plus x-rays etc came to just over $2.3K of which I got a bit under a third back from medicare.

Getting the money back was relatively easy. Just need to get all the relevant people to fill in their section and then you send it in. Had a few phone conversations with the insurer about the physio being included, as I got the Surgeon to fill in the form prior to realizing that my shoulder was frozen. So needed to get another letter from the surgeon to say it was indeed needed due to the crash.

Best of luck!

Thanks for that.

Yeah I am getting my collar bone plated to as I have to go under for my elbow.

The excess on MTBA is $75 but unsure if that is per session or per provider.

Started getting all my income protection stuff started today. Will hopefully get doctor to fill it in while in for surgery.

I have no idea what will be covered under medicare in terms of rehab and physio.

They don’t tell you a lot about money at the hospital, but it is clear I don’t have private.

ACC is so much simpler in NZ.

I might look into private health insurance after surgery and once I can get some straight answers from people about money.

edit: I a referring to doctors etc, not people on here.

In terms of physio and rehab, Medicare is pretty non-comprehensive. When I did my collarbone last year, they just had a physio come around as I was being discharged and gave me some exercises to do. As for the actual surgery, pretty straightforward and free.

Are you being operated on in the public hospital as a public patient? Then you shouldn’t pay anything.

I believe so.

$75 excess was for the whole claim and was deducted from my total reimbursement.

I went to a local physio I knew. My private health fund I signed up for paid $50 of each $84 physio session, the remaining $34 per session was included in my payout to the $5000 limit.

Good to know, just got the bill from Mansfield hospital for after hours and x-rays so I can add that to the medical bill claim.

boourns, but a better heal overall.

Temp plate or lifetime?

Think permanent, well review after 6 months

Whatever you do, get started on rehab as soon as possible!

My arm was immobile nearly 10 weeks in total - 2 weeks from crash to surgery as happened just before Easter plus time afterwards… Getting my frozen shoulder moving again was the most painful experience and took months of physical manipulation!

If your break is amenable, always ask for a pin, the pins are titanium, never removed and you can ride and ski straight away.

I did no formal rehab.

Unfortunately seems to be only certain surgeons and for those with private insurance.

From memory pinning is more complex and slightly higher risk, but I don’t know that much about it. It’s always good to listen to the advice of a professional.